VICTORY: Blue Cross Blue Shield Illinois May Not Exclude Gender-Affirming Care in Any Health Plan Across the U.S.

"Thousands of transgender people in Blue Cross Blue Shield of Illinois-administered health plans will have access to the health care they need."

(Tacoma, WA, December 20, 2023) - Today, U.S. District Court Judge Robert Bryan instructed Blue Cross Blue Shield of Illinois (BCBSIL) to cease imposing discriminatory exclusions on gender-affirming care in all of its health plans across the country. The court's Order forbids BCBSIL from applying such discriminatory exclusions even when requested to do so by an employer. The injunction makes no exception for religious employers.

The Court also ordered BCBSIL to reprocess claims for gender-affirming care that it previously denied, going back to October 30, 2014. Today's ruling is the first in the country to order a third-party administrator, like BCBSIL, to refrain from administering discriminatory exclusions at the behest of employers. Millions of Americans receive their health coverage in self-funded plans that are managed by third-party administrators which are also subject to anti-discrimination laws.

The ground-breaking decision came in C.P. et al., v. Blue Cross Blue Shield of Illinois, a class action lawsuit filed by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC in the U.S. District Court for the Western District of Washington in Tacoma. The case was initially filed by C.P., a now 18-year-old transgender young man, and his parents. The original plaintiffs have been joined by S.L, a 12-year-old transgender girl, by and through her parents, and Emmett Jones, a transgender man. The lawsuit alleged that BCBSIL's administration of exclusions of gender-affirming care violates the health nondiscrimination law enacted as part of the Affordable Care Act, known as Section 1557.

In December 2022, the Court concluded that BCBSIL discriminates against transgender enrollees when it enforced categorical exclusions of gender-affirming care, even in self-funded plans that may be designed by employers. Despite the Court's decision, BCBSIL continued to administer the exclusions in 2023. To force BCBSIL to adhere to the Court's legal conclusion, the C.P. Plaintiffs moved for a permanent injunction and reprocessing.

"With this decision, the court made clear not only that Blue Cross Blue Shield of Illinois must not administer any categorical exclusions of coverage for gender-affirming medical care in the future, but that it must reprocess all the claims that it unlawfully denied when it administered the exclusions against class members. Thousands of transgender people in BCBSIL-administered health plans will have access to the health care they need, said Omar Gonzalez-Pagan, Counsel and Health Care Strategist for Lambda Legal. "Last December, the court was unequivocal about categorical exclusions for coverage of gender-affirming care being unlawful discrimination and that health insurers who receive federal funds and act as third-party administrators have an independent duty not to administer discriminatory ERISA health plans. BCBSIL must now notify all class members of the ruling, stop enforcing such exclusions, and process or reprocess claims accordingly."

"BCBSIL is not unique," said Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger. "Other health insurers and third-party administrators implement the same discriminatory exclusion with impunity. This decision sends a warning that they should heed: Health companies governed by the Affordable Care Act cannot engage in discrimination, even when asked to do so by an employer."

"My family has waited for this day for years," said Pattie Pritchard, C.P.'s mother. "We are thrilled that BCBSIL has been told, definitively, that it cannot discriminate against my son or anyone else just because they are transgender. I hope that other health companies also get the message sent by the Court's order. No one should be denied needed medical care because of their sex."

In the decision, U.S. District Judge Robert J. Bryan stated:

"Blue Cross violated Section 1557. Blue Cross as a third party administrator is a covered entity under section 1557 and has discriminated on the basis of sex against the Plaintiffs and the class Plaintiffs by denying them services for gender affirming health care under individual and class Plaintiffs' insurance policies. Classwide declaratory and injunctive relief is necessary to ensure that class members have their past, present and future claims for gender affirming health care adjudicated without discrimination."

The case is?C.P. v. Blue Cross Blue Shield of Illinois?and is being litigated by Counsel and Health Care Strategist Omar Gonzalez-Pagan, Chief Legal Officer Jennifer C. Pizer, and Director of Constitutional Law Practice Karen Loewy for Lambda Legal, and Eleanor Hamburger and Daniel Gross of Sirianni Youtz Spoonemore Hamburger PLLC, in Seattle, Washington.

Read the court's order here:? Order on Plaintiffs' Motion for Classwide Relief and for Nominal Damages - Lambda Legal

Learn more about the case here:?https://www.lambdalegal.org/in-court/cases/cp-v-bcbsil

Find a digital version of this press release here: https://lambdalegal.org/newsroom/cp_wa_20231220_victory-blue-cross-blue-shield-of-illinois-may-not-exclude-gender-affirming-care-in-any-health-plan/

Lambda Legal is a national organization committed to achieving full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and everyone living with HIV through impact litigation, education and policy work. www.lambdalegal.org